Nonessential medical staff adapt to change in role on pandemic front lines

WASHINGTON — As the coronavirus continues its rampage through the United States and most workers are advised to stay home, non-emergency room medical staff continue to go to work without the same support front line E.R. doctors receive.

Because many of them aren’t in charge of confirmed cases of the virus, non-emergency room doctors and nurses have been pushed to adopt new technologies to follow check-up appointments through video-consultations while facing a shortage of personal protective equipment, or PPE, that more often gets donated to staff in the emergency room.

Al Ghilardi, a surgical first assistant at Mount Auburn Hospital in Cambridge, MA, where over 200 people have tested positive since early March, said they had to put away masks, gowns, scrubs and other protective equipment because people started taking it home, worsening the PPE supply.

The hospital stopped performing elective surgery shortly after the first confirmed case. Instead, the staff began carrying out simulation surgeries to prepare for when they had to do surgery on COVID-19-positive patients.

“When we realized things weren’t going to lighten up, the hospital started going on COVID-mode,” he said.

Ghilardi and the rest of the assisting team would get dressed in the hallway to avoid contaminating the operation room. In addition, they all wear shoe-covers, a full-body gown, eye protection, two pairs of gloves so if it’s needed, one can take off the first pair and still be protected, and N-95 respirator masks with a surgery mask on top of it.

But Ghilardi’s team is perhaps lucky, as it has more equipment available to use than many smaller units around the area. Grace Canavan, a behavioral health nurse at an acute care hospital in New Hampshire, received a flu mask only last week as most masks have been given to emergency room staff since the outbreak.

“People are forgetting that [every hospital unit] needs the same type of support,” Canavan said. “These patients are coming from the same place as people with COVID-19, and they are just as likely to be exposed [to the virus] but because they are so focused on Intensive Care Units, units like behavioral health are the last ones to get the support we require.”

Many nurses have been temporarily deployed to COVID-19 modules within their hospital to assist with the high number of incoming cases every day, Ghilardi said, which leaves non-essential units with even less resources to treat their patients. In New York, over 2,500 nurses from across the country have been deployed to local hospitals’ ICUs and COVID-19 testing sites to help monitor the growing number of confirmed cases.

A cargo plane carrying almost 100,000 pounds of PPE landed in New Hampshire on Sunday, Governor Chris Sununu tweeted. The shipment, which included 6.6 million masks and 50,000 face shields, will be given at no cost to “areas of greatest need across the state,” officials said. Officials didn’t clarify whether non-essential medical units and small practices would receive part of the PPE.

Regardless of the lack of protective resources, Canavan is not afraid to go to work every day and expose herself to the virus.

“I’m not happy this is happening, but I’m happy I can help in any way I can,” Canavan said.

Ghilardi, who has been on a paid furlough for two weeks, will not hesitate to go to work if he’s called in for an emergency spinal or orthopedic surgery.

To follow the CDC’s guidelines, Canavan said, her hospital’s administration has most recently limited the number of people allowed to come in for their therapy appointments given the possibility of contracting the virus, as patients must check-in through the emergency department.

Given the uncertainty and fast spread of the virus, many hospitals across the nation have had to make critical infrastructure changes, including repurposing rooms into non-COVID-19 ICUs and developing new entrances to keep coronavirus-positive patients apart from possibly non-infected patients, among others.

At Mount Auburn, Ghilardi said, recovering patients will remain in the operation room following their surgery – instead of being transferred to the designated recovery room – until the anesthesia has worn off and they are moved to the floor for observation. The change was made three weeks ago as the hospital transformed the recovery room into an ICU for non-COVID-19 patients.

“This is a lot scarier to me than the AIDS epidemic was,” Ghilardi said, as he recognized the current virus is more easily spread and many people still don’t follow basic CDC guidelines.

Community Nurse Mikayla Perella, who currently works at a day program for adults with developmental disabilities in Massachusetts, only entered the workforce a year ago, and she admits to not having been taught how to act in such a situation during her four years at University of New Hampshire.

“It’s very scary for something this unprecedented to happen during your first year as a nurse. It’s kind of wild,” she said. “When you turn on the news, all you see is E.R. nurses and E.R. doctors, but what you don’t see is that there are direct care workers that work day-to-day jobs in nursing homes or group homes – they are the ones who are really at risk because they don’t have hospital care that protects them. What they do is just as important as those that are getting exposed on a day to day basis in the emergency room.”